Smokers need not apply for jobs at Penn medical system

Joins other hospitals in refusing to hire anyone who smokes, even off-premises.

The University of Pennsylvania Health System, a large teaching hospital system, has announced a new policy under which it will refuse to hire anyone who smokes. Set to go into effect on July 1, the plan will involve asking every new hire whether he or she smokes as part of the interview process. Those caught lying after being hired would face disciplinary action that could include termination.

The policy may seem like a radical new step, but the first policy of this kind was implemented back in 2007, and a number of other hospital systems have followed suit. Penn notes that a federal appeals court ruled in 1987 that smokers are not a protected class, although 29 states have laws on the books that prevent hiring decisions from being made based on whether an applicant smokes. One of those 29 is right across the Delaware River in New Jersey, where Penn has some facilities that will not be able to implement the policy.

Aside from the obvious reason—an organization dedicated to health really should not provide a welcoming environment for the single-largest cause of preventable deaths in the US—the policy statement notes that employees who smoke rack up an average of over $3,000 in extra health care costs per year. Smoking breaks are also disruptive and "subject patients/colleagues to the unpleasant smell of smoke on employees' scrubs and clothing."

Although the Penn announcement states the organization has "no specific plans to restrict employment for other conditions," it notes that it is committed to the health and safety of its employees, which would seem to open the door to further measures in the future.

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The Cleveland Clinic has publicly stated that if they thought they could legally discriminate based on weight they would. For now they've settled for smoking. Existing employees aren't fired for smoking, but they must participate in smoking cessation programs (at the Clinic's expense) and make discernible progress in those programs. They won't hire new smokers.

248 Reader Comments

Why would a patient suffering from some lung or airway disease want to be treated by someone reeking of cigarette smoke? I wish this were implemented in more places - it's a common sense measure for a place supposedly a paragon of health to prohibit an unhealthy behavior in its employees that extends into their workplace and affects their patients. You cannot argue that someone who smokes outside of work will be indistinguishable from other employees, as lingering tobacco and smoking breaks demarcate them from their more sensible non-smoking co-workers. I agree completely that companies should have no influence over what their employees do outside of work, except in cases in which their external activities have a direct impact on their workplace, which smoking does in fact have.

Finally, it's important to remember that smoking is not a human right. Smoking is a destructive behavior which harms its practitioners and those around them. Just as people would not indulged if they wanted to deliberately infect themselves with smallpox for fun and then go to work at hospital, smoking (though it is less pernicious than smallpox and secondhand smoke less contagious) is not something that should be assumed a right in somewhat unclear cases such as this, as it is indeed a public hazard.

As much as I want to hop on the smokers-take-too-many-breaks bandwagon, this is something that I feel needs to be addressed: There's no upside to smoking. All smoking does is (slowly) make people sick and eventually kill them if something else doesn't get there first. As far as I know, there's no psychological upside to smoking that isn't just temporarily abating one of the downsides of nicotine addiction.

So we're talking about people who consciously make a decision to effectively injest a largely non-recreational and addictive poison on a regular basis who also want to be employed in the health care industry. Is that not a disqualifying personality flaw? I apologize if this comes off as sanctimonious, but as a non-smoker I just can't comprehend smoking as anything but self-destructive. I don't want my doctor to be self-destructive.

How can you have confidence in the medical advice and care of a doctor who doesn't take the risks of smoking seriously?

While I am not a proponent of smoking, your statement about no upside is completely false.

Yes, everyone knows about the danger and health risks of smoking. Or at least what the PSA's have told us.

But the simple fact is that nicotine has many beneficial effects. It is both a stimulant and relaxant. It improves fine motor skills, attention and memory. It also reduces anxiety. So, things that would actually be of value to someone working in a stressful situation, like a hospital. Additionally, nicotine has been linked to beneficial effects regarding Alzheimer's.

And yes, cigarette smoking is bad. Cigarette smoking is carcinogenic. But nicotine itself is not carcinogenic, the burning tobacco smoke is. Tobacco smoking is bad, but nicotine, in and of itself, isn't particularly evil.

I am not advocating smoking. And yes, the risks far outweigh the benefits. However, to say there is no upside or medical benefits at all to smoking shows ignorance of the facts.

Honest question: Do you really know anyone who you would consider a "smoker" who doesn't smoke during work hours? I don't. Once you hit "smoker" status you're addicted, and you're not going all day without your fix.

I have 2 friends that I work with that don't smoke all day. When they get home they have a few cigarettes after dinner. Both smoke a few on the golf course.

Being a former smoker (12 years no smoking now) I can't understand their self control but it works for them.They don't even go out to smoke if we are having beers after work.

Honest question: Do you really know anyone who you would consider a "smoker" who doesn't smoke during work hours? I don't. Once you hit "smoker" status you're addicted, and you're not going all day without your fix.

That may be but a smoke break is typically what? Five minutes or so for most people? If a few are taken periodically throughout the day, we're talking the equivalent of two 15-minute breaks that everybody else typically takes. Let's also not pretend like there aren't non-smokers who sit around "shooting the breeze" with co-workers and doing other non-productive stuff, sometimes for hours.

The point (for me at least), is not that smokers are taking more breaks than other people, it's that if they smoke during work hours, they are going to carry that scent around with them. I can't stand that smell, and would definitely change hospitals if I had to run into it at one, but not at another. (By the way, I feel the exact same way about strong perfume/cologne - I have a mild allergic reaction to it, and usually end up speedily leaving the area, coughing.) I don't think it's unreasonable for a company to dictate that people that interact with customers a lot (ie, most doctors/nurses) be as inoffensive as possible. By the same measure, I absolutely don't care if they do it at home. But, as Aurich pointed out, most people who I've met who'd call themselves a "smoker", isn't going to want/be able to keep away from it for 8 or however many hours their shift is.

Sounds like your problem is people having any scent at all. This is not my problem, however. Asking for it to be my problem is basically an intrusion.

We had a pair of older secretaries who'd been working at my firm since before I was born (and I'm in my 40s) die of cancer in the past four years. Both of them had been life-long smokers, and both of them battled cancer bravely for the last several years of their lives.

It's not a coincidence that all the employees' health-insurance premiums went way up the year after the first cancer case.

Ummm how many people are insured by your insurance company? Unless it is a tiny amount then this is just gouging. Not surprising but shifty none the less.

Many employers have what is known as a "self-insured" plan. The employees will all get your usual insurance cards/coverage, etc. from someone like Blue Cross. But the employer, rather than paying a fixed monthly premium for their employees, pays a tiny admin fee. In return, the employer is responsible for the cost of any claims made. So if the claims are less than the premiums for a fully-insured plan would have been, the company comes out ahead.

This is generally going to be for a large company - I don't know how big the firm in question was - but if they're self-insured that may be why they saw such a big shift in the employee cost.

When I see nurses outside on smoke breaks, still wearing their scrubs and little booties, it just makes me shake my head. You're really going to walk back inside to do who knows what in the hospital reeking of smoke?

Sorry, but so what?

You don't like the smell of smoke. Fair enough. And you'd have a real argument if someone was sitting in the hospital blowing smoke into your face. But we are talking about smoke residue on someone's clothes/body. Thing is, what in the world does that have to do with a person's ability to competently perform their job?

I went to the ER for a bad asthma attach once, and one of the aides working on me reeked of cigarette smoke. That made the attack so much worse I almost lost consciousness. My brother finally realized what was happening (I couldn't breathe enough to tell them) and got the guy out of there. Maybe not a big deal in some other setting, but in a hospital/medical setting IT IS A BIG DEAL.

Well then you might as well ban any sort of scent, like perfumes. Because it is likely you would have the same response to a host of other odors.

I'm allergic to patchouli. I am also allergic to cat hair. I react physically to it. But I don't sit around demanding sanctions against people wearing patchouli or owning cats. To be fair, I don't have asthma, but I do have a fairly severe reaction to patchouli.

Well then you might as well ban any sort of scent, like perfumes. Because it is likely you would have the same response to a host of other odors.

Actually a number of hospitals (particularly cancer centers and children's and gerontology facilities) have instituted fragrance-free policies where you have to be completely unscented to walk in the building.

But, on the other hand, telling someone who isn't anywhere near your hospital that they can't smoke is overstepping bounds. While smokers aren't a protected class, they can still exercise the ability to choose. If they choose to smoke in their own homes, or somewhere else that allows smoking, they should be able to do so. They'll just have to invest in some nicotine gum for when they're at the hospital.

As much as I want to hop on the smokers-take-too-many-breaks bandwagon, this is something that I feel needs to be addressed: There's no upside to smoking. All smoking does is (slowly) make people sick and eventually kill them if something else doesn't get there first. As far as I know, there's no psychological upside to smoking that isn't just temporarily abating one of the downsides of nicotine addiction.

So we're talking about people who consciously make a decision to effectively injest a largely non-recreational and addictive poison on a regular basis who also want to be employed in the health care industry. Is that not a disqualifying personality flaw? I apologize if this comes off as sanctimonious, but as a non-smoker I just can't comprehend smoking as anything but self-destructive. I don't want my doctor to be self-destructive.

How can you have confidence in the medical advice and care of a doctor who doesn't take the risks of smoking seriously?

I'm a non-smoker, and you aren't wrong about smoking. It is a bad thing. In exchange for a whole slew of nasty chemicals and poisons, it offers small high that will only have less effect as time goes on. As you say, it doesn't have an upside.

But, it's still a choice. Regardless of whether or not it's a good one, it's your body and if you want to put poison in it, that's your call. There is some irony and hypocrisy in a healthcare worker smoking, but it's your choice as a patient whether or not you see that worker. By the same token, it's the hospital's choice whether or not it allows smoking in or near its facilities. However, dictating to its workers what they can and can't do when they aren't at the hospital is an overstepping of boundaries, at least in my opinion.

I hate smoking. I find it annoying, disgusting and inconsiderate. I hate employers deciding what we can do during our unpaid hours to be the greater threat.

We are not machines owned by corporations. We have rights, they exist at our sufferance, not the other way around.

Actually they are setting a standard for who they will hire. they aren't telling you what you can or can't do. If you apply to work for them knowing full well what they will be expecting of you then you have nothing to really complain about. No one owes you a job. Try to remember this is an employer's market. Just because you refuse to meet their standards doesn't mean there aren't PLENTY of unemployed people out there right behind you who will do it gladly. Because there are.

Well then you might as well ban any sort of scent, like perfumes. Because it is likely you would have the same response to a host of other odors.

Actually a number of hospitals (particularly cancer centers and children's and gerontology facilities) have instituted fragrance-free policies where you have to be completely unscented to walk in the building.

I guess an employee could smoke, if they could come to work without smelling of it, and they could refrain until they're back home.

Otherwise no, wouldn't hire them, good and fair decision from Penn medical. It is evidence of a lack of judgement, will, regard for others and a good indication that they will be generally less healthy than other employees. Not to mention the "smoke breaks" every smoker I have ever worked with felt was their entitlement.

This is generally going to be for a large company - I don't know how big the firm in question was - but if they're self-insured that may be why they saw such a big shift in the employee cost.

Yup, I work for a self-insured company, with several thousand employees. A couple years back, we had a few employees experience catastrophic medical issues. It ended up raising everyone's rates a bit. Why yes, when the average employee only costs you about $3,000/year to insure, and you get 5 employees that suddenly cost $350,000, that does tend to require an influx of money to pay off.

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That's an impossible requirement. No one is hypoallergenic.

Don't be obtuse. They're a difference between "don't wear perfumes and other scented skin and hair products" and "you must be hypoallergenic". Yes, plenty of medically sensitive employers have that requirement. I suppose you should inform them that they're asking the impossible.

On the one hand, keeping smoking away from a hospital doesn't strike me as a bad thing. Smoking isn't a good thing for anyone, either for the smoker, or anyone caught upwind. Plus, an institution can say what can and can't be done on its premises.

But, on the other hand, telling someone who isn't anywhere near your hospital that they can't smoke is overstepping bounds. While smokers aren't a protected class, they can still exercise the ability to choose. If they choose to smoke in their own homes, or somewhere else that allows smoking, they should be able to do so. They'll just have to invest in some nicotine gum for when they're at the hospital.

They do have a choice. They can choose to work for a company that doesn't have rules against hiring smokers.

They can indeed. Many probably will. But, that doesn't mean that the hospital should be able to dictate what its workers do when they're not at work.

A hospital deciding that its campus is completely smoke-free and leaving it at that is just fine. Workers can leave the cigarettes at home, and bring nicotine gum with them. Who knows, maybe such an action will help them kick the habit. But, for the hospital to tell its workers that they can never smoke, ever, infringes on the personal right of choice.

I engage in risky practices off the clock--I spend many, many hours every spring-fall out looking for rattlesnakes so I can document frequency, photograph them, and just enjoy seeing them. I also work with large, non venomous snakes at home. And yes, I have missed work due to injuries sustained in the pursuit of these hobbies; never been bit by a rattler, but tramping around in rough country a lot, things can happen--and I have been bitten by a large reticulated python and had to call in to go get treated for puncture wounds. I would flip out if my employer told me not to do those anymore because it meant I used some of my available PTO to deal with injuries sustained during it.

Most of us have hobbies/interest that can put us at risk and cause us to miss work or increase health cost. I don't like smoking--never have smoked, never will. My great grandmother died of emphysema that was probably caused by smoking. One of my favorite great-uncles got cancer in his jaw from nicotine use. I hate the stuff.

But if you don't let it impact you on the clock? You don't take extra breaks? You don't use on company property? Then it's a dick move to decree you won't hire them. It may be legal--I'm not a legal expert but I'm assuming they vetted this through attorneys. But it's still a dick move.

[/quote]Really, this - along with other increasingly invasive decisions some employers are choosing to make (e.g. Facebook stalking, drug tests, firing employees for lewd behaviour outside working hours, etc.) is justification for me for governments to start enacting new legislation that limits the control and authority employers have outside the workplace.[/quote]

This. In general, I'm seeing more and more trend towards employers keeping track of way more of people's personal lives than I want to. It's one thing to fire your CEO or spokesperson for getting caught with a dead hooker and a lb of cocaine in his care...it's entirely different to fire someone for posting a picture of themselves legally enjoying a glass of wine on facebook, or smoking a legal substance in their off time, or donating to political causes you don't like.

I'm honestly disturbed by some of the reactions here because this is a flat out moronic policy. It genuinely makes me angry to see so much support for it.

If hospitals should be refusing to hire anyone then it should be people who don't wash their hands after using the bathroom. Which is something like 40% of the population and infinitely more hazardous in a hospital setting than any smoker who does wash his hands.

I happen to work in hospital IT and I have two coworkers with skin diseases that prevent them from using soap. I'd be pissed off as hell if they lost their jobs (because they're immensely well for qualified for them) yet there is far greater reason to dismiss those two than any smoker on the job. Can you guess which is a greater risk to sterilized operating rooms?

I just want to say, as a nurse, it really sucks when frequently (i.e. virtually every work day) you routinely miss bathroom breaks, lunch and dinner breaks, and god forbid you have a 15 minute break. when you haven't eaten, peed, or just had a moment to sit and not do anything for hours and hours and have colleagues running out for smoke breaks, it does tend to hurt morale of the unit.

I'm slightly conflicted on whether this policy is a Good Thing or a Bad Thing overall but it sounds like at the very least, it's a Not As Good As It Could Be Thing.

I can see this policy might stigmatise smokers, which doesn't strike me as particularly fair when most smokers want to quit and have made at least one attempt. Rather than a policy that implicitly pours shame on people with an addiction that they want to shake, how about a supportive, positive policy that might benefit everyone?

I'm thinking along the lines of a policy where smokers are hired on condition that they limit their smoking to outside of work hours while part of their probation involves getting counselling from a smoking cessation service, seeking out nicotine replacement therapy, or both, or any number of evidence-based interventions that can help a person quit. Better yet, these could be paid for, at least in part, by the employer. They are a hospital, after all...And money should be available if they're saving $3,000 per year for every person who successfully quits.

This won't satisfy people who have a principled objection to employers telling employees what they can do outside of work but maybe it would neutralise a lot of it. I think it could turn "how dare this employer tell me I can't smoke in my own time?!" to "how great that my employer gives a damn about my health and is willing to pay to help me quit after all these years".

This is incredible overreach on the part of an employer into an employee's personal life.

This is not about the employees. This is about the patients. There are people who are so sensitive to tobacco smoke that they can have trouble breathing because of second-hand smoke even if that smoke is only in the smoker's clothes.

I know this because my father was one of these sensitive people.After half a lifetime of smoking, my father got cancer in the larynx, and the larynx had to be removed. After the laryngectomy, he had to breathe through a hole in the throat. He had to wear an air filter over his breathing hole but that was not enough. Irritants in the trachea were carried by mucus to the opening which he had to clean with a vacuum pump at least ten times every day and in the middle of the night -- and more often if subjected to bad air.Once, nurses had to sedate him so that he could not clean his breathing hole himself. A few nurses went smoking on the balcony next to his room and entered his room carrying smoke in their lungs and in their clothes. His trachea became irritated and the mucus built up. His breathing hole was not cleaned and he suffocated to death.

Employer-provided health care is insanely retarded and this is yet another reason why. Either the government or individuals should pay for health care. In either case, individuals should be able to choose what they do in their free time. My employer doesn't own me - it only owns the work I do on the job.

Smoker's at some companies pay extra for insurance, we have a $50/month surcharge for smokers at mine. Banning smoking on the premises seems like a supportable position given their points about disrupting patient care due to frequent breaks or smell.

That is how mine works and the additional charge goes on your fee until you have been smoke free for 10-15 years... Then there is the additional "cancer insurance" you can add to your plan.

Dang, for our plan it's $50 if you smoke unless you join a 'smoking cessation program' and then quit, no long-term punishment for having smoked previously.

But if you don't let it impact you on the clock? You don't take extra breaks? You don't use on company property? Then it's a dick move to decree you won't hire them. It may be legal--I'm not a legal expert but I'm assuming they vetted this through attorneys. But it's still a dick move.

The thing is, it DOES affect the employer. At least statistically speaking. They pay out more money in insurance coverage for smokers. Smokers take more sick leave. They are less productive. To say that they're doing this on their own time doesn't cover the whole story. It DOES have an impact on the employer, it IS a choice and not-protected status (in some states), so they DO have a right to screen for it.

As for other high risk activities, you know, if 46 million Americans went out snake hunting each weekend, and there was an established increase in medical costs and lost productivity, then companies might want to screen against it. As it is, I'm guessing the cost/benefit ratio for screening those people out isn't worth it.

I'd love to see companies be allowed to create multiple insurance groups for their employees. Those who don't smoke, and maintain appropriate weight and blood pressure can be in one group, those who attempt slow suicide can be placed in another... then let natural market dynamics control the price. If smokers were paying 10x the insurance premium that non-smokers did, they'd seriously reconsider. By forcing everyone to be in one group, the healthy people are subsidizing the smokers' habit. Car insurance companies do this to some degree when they charge higher premiums to people who get lots of tickets or accidents right?

I am 100% against smoking. Blah, blah, blah, anecdotes that never happened in your life to justify what you were feeling anyway... Putting aside the well-documented impact to one's health, to me lighting up is pretty much the same as taking a shit on some paper, rolling it up, igniting it, only to inhale and exhale the smoke from the newly formed shit stick. I feel dirty when I'm near a smoker. I don't know how they even start.

Gee, something you don't understand. Guess you better hate it with all your might.

Findecanor wrote:

Gawain Lavers wrote:

This is incredible overreach on the part of an employer into an employee's personal life.

This is not about the employees. This is about the patients. There are people who are so sensitive to tobacco smoke that they can have trouble breathing because of second-hand smoke even if that smoke is only in the smoker's clothes.

I know this because my father was one of these sensitive people.After half a lifetime of smoking, my father got cancer in the larynx, and the larynx had to be removed. After the laryngectomy, he had to breathe through a hole in the throat. He had to wear an air filter over his breathing hole but that was not enough. Irritants in the trachea were carried by mucus to the opening which he had to clean with a vacuum pump at least ten times every day and in the middle of the night -- and more often if subjected to bad air.Once, nurses had to sedate him so that he could not clean his breathing hole himself. A few nurses went smoking on the balcony next to his room and entered his room carrying smoke in their lungs and in their clothes. His trachea became irritated and the mucus built up. His breathing hole was not cleaned and he suffocated to death.

Ah, so the thing with the patients, that's the problem YOU have. Shocking, that. Thanks for declaring your own emotional troubles must be the issue at hand. Get help.

igor.levicki wrote:

seanhsmith wrote:

Here's hoping that the Penn medical system misses out on hiring a lot of very talented people. You reap what you sow. What people do on their own time is none of their damn business.

Yes, if you are a drug addict in your free time that has absolutely nothing to do with your job performance, right? Give me a break!

Anything to protect your precious self-image. Obviously all those people doing things that you didn't choose to in your life must be bad, horrible people, making you a paragon of light in comparison. And such a better worker, too, than all those "drug addicted" straw men implied in your argument!

I'd trust a pack-a-day smoker long before I trusted anyone with your ignorant attitude of smug superiority in a position of real authority.

I can't believe how many jerksacks are in here brushing off perfectly legitimate issues with smokers working at hospitals. Allergic reactions, compromised respiratory systems, etc. etc. are apparently not anybody's problem if you're not a sufferer yourself. What a bunch of entitled whiners.